Influence of nerve identification and the resection of nerves ‘at risk’ on postoperative pain in open inguinal hernia repair

Abstract

This register study confirms the importance of nerve identification. Nerve resection strategy with the consequent removal of nerves 'at risk' gives a significantly better outcome in Lichtenstein hernioplasty.

Anatomic variability of groin innervation

“…Damage to the inguinal nerves has been associated with long term postoperative groin pain [2,3,7]. The highest level of self-reported postoperative pain, at 3 months, has been found to be correlated with non-identification of the ilioinguinal nerve [7]. Fortelny and Petter Puchner [3] estimate the incidence of postoperative of Hasselbach's triangle, it pierced the transversalis fascia and entered the canal (Fig.…”

“…Variation in the anatomical course of the inguinal nerves further complicates this already demanding procedure as nerves may be inadvertently compressed or sectioned. Injury to the innervation of this area can lead to postoperative pain [6,7]. For instance, in 49 out of 110 hernia repairs reported by Al-Dabbagh [1], the atypical superficial placement of the ilioinguinal nerve left it particularly vulnerable to transection in the early stages of the operation.…”

Effectiveness of Multiple Neurectomies to Prevent Chronic Groin Pain After Tension-Free Hernia Repair

“…Two large prospective studies have shown the importance of all 3-nerve identification during the open inguinal hernia repair. [7][8][9] Recent anatomic studies have elaborated the course of GFN, in an aim to remove the myth that identification of GFN is difficult. [10][11][12] The genitofemoral nerve originates from L1/L2 and pierces the iliopsoas muscle where it lies on its ventral surface.…”

A New Prosthesis in Inguinal Hernia Repair: Results of a Pilot Study

“…According to the International Association for the Study of Pain (IASP) chronic groin pain was "groin pain reported by the patient at or beyond 3 months following inguinal hernia repair. 3 Post-operative pain may be incapacitating and can dramatically affect quality of life; the reported incidence of chronic pain 1 year after hernia repair varies from 0.7 to 28.7%. 4 Management of chronic groin pain constitutes a challenging issue for the clinician, often more challenging than deal-ing with recurrence.…”

“…According to the literature, perioperative nerve damage, postoperative fibrosis, and mesh related fibrosis are the main reasons for chronic groin pain. 4,5 In attempts to reduce it, researchers have tried various surgical techniques and materials.…”